{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:00:25Z","timestamp":1788868825455,"version":"build-2803163510"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Coronary heart disease (CHD) remains a major cause of morbidity, mortality, and healthcare costs. The coexistence of Type 2 diabetes mellitus (T2DM) further amplifies these burdens. This study examined integrated care pathways for individuals with CHD and T2DM to identify healthcare interactions associated with better outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Linked administrative datasets (2010\u201322) from general practices (GPs), emergency departments (ED), inpatient, and mortality records in Western Australia were used. Coronary heart disease cases (ICD-10-AM: I20-I25) presenting to EDs (index event) were matched with healthcare data. Among patients with comorbid T2DM (n = 2085), the care pathway was analysed using descriptive statistics, Cox regression, and discrete-time survival models. A doubling of post-CHD GP visits was associated with reduced odds of recurrent rehospitalization [adjusted odds ratio (aOR) = 0.94; 95% confidence interval (CI), 0.92\u20130.97] and lower mortality risk (adjusted hazard ratio (aHR) = 0.87; 95% CI, 0.84\u20130.90). Conversely, a doubling of pre-CHD GP visits was associated with increased odds of rehospitalization (aOR = 1.04; 95% CI, 1.01\u20131.06) and mortality (aHR = 1.09; 95% CI, 1.05\u20131.11). Patients living in outer regional areas had higher odds of rehospitalizations, while older age, remote residence, and comorbid heart failure or chronic kidney disease were associated with elevated mortality. Overall, 73.7% of patients received at least one guideline-recommended CHD medication, and 34.0% were prescribed metformin, often alongside insulin, and dipeptidyl peptidase-4 inhibitors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater GP engagement following CHD was linked to improved survival and fewer rehospitalizations. Pre-CHD GP visits may reflect greater baseline risk. Strengthening primary\u2013secondary care coordination could improve outcomes and reduce long-term healthcare burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjcn\/zvag079","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T18:27:29Z","timestamp":1773858449000},"page":"1170-1182","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare pathways and health outcomes among people with coronary heart disease and Type 2 diabetes in Australia: a linked data analysis"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9963-7591","authenticated-orcid":false,"given":"Sangita","family":"Shakya","sequence":"first","affiliation":[{"name":"Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University , 221 Burwood Hwy, Burwood, VIC 3125 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2756-5090","authenticated-orcid":false,"given":"Sean","family":"Randall","sequence":"additional","affiliation":[{"name":"Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University , 221 Burwood Hwy, Burwood, VIC 3125 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-6475","authenticated-orcid":false,"given":"Suzanne","family":"Robinson","sequence":"additional","affiliation":[{"name":"Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University , 221 Burwood Hwy, Burwood, VIC 3125 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6075-8548","authenticated-orcid":false,"given":"Paul A","family":"Agius","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Health and Social Development, Deakin University , 221 Burwood Hwy, Burwood, VIC3125 ,","place":["Australia"]},{"name":"Burnet Institute Disease Elimination, , 85 Commercial Rd, Melbourne, VIC 3004 ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , The Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6613-5491","authenticated-orcid":false,"given":"Crystal Man Ying","family":"Lee","sequence":"additional","affiliation":[{"name":"Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University , 221 Burwood Hwy, Burwood, VIC 3125 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2722-9975","authenticated-orcid":false,"given":"Kevin E K","family":"Chai","sequence":"additional","affiliation":[{"name":"School of Psychology and Public Health, La Trobe University , Plenty Road, Bundoora, VIC3086 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8925-8811","authenticated-orcid":false,"given":"James H","family":"Boyd","sequence":"additional","affiliation":[{"name":"School of Psychology and Public Health, La Trobe University , Plenty Road, Bundoora, VIC3086 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1381-4981","authenticated-orcid":false,"given":"Bernard Kwadwo Yeboah","family":"Asiamah-Asare","sequence":"additional","affiliation":[{"name":"Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University , 221 Burwood Hwy, Burwood, VIC 3125 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3608-400X","authenticated-orcid":false,"given":"Richard","family":"Varhol","sequence":"additional","affiliation":[{"name":"School of Population Health, Curtin University , Kent Street, Bentley, WA 6102 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9734-1140","authenticated-orcid":false,"given":"Lan","family":"Gao","sequence":"additional","affiliation":[{"name":"Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University , 221 Burwood Hwy, Burwood, VIC 3125 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026090719584613700_zvag079-B1","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","article-title":"The global burden of cardiovascular diseases and risk: a compass for future health","volume":"80","author":"Vaduganathan","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026090719584613700_zvag079-B2","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B3","author":"Institute for Health Metrics and Evaluation"},{"key":"2026090719584613700_zvag079-B4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/2047487314554865","article-title":"Projected age- and sex-specific prevalence of cardiovascular diseases in Western Australian adults from 2005\u20132045","volume":"23","author":"Sarink","year":"2016","journal-title":"Eur J Prev Cardiol"},{"key":"2026090719584613700_zvag079-B5","author":"Australian Commission on Safety and Quality in Healthcare"},{"key":"2026090719584613700_zvag079-B6","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B7","author":"Hendrie"},{"key":"2026090719584613700_zvag079-B8","doi-asserted-by":"crossref","first-page":"e053001","DOI":"10.1136\/bmjopen-2021-053001","article-title":"Understanding the cost of care of type 2 diabetes mellitus\u2014a value measurement perspective","volume":"12","author":"Doyle","year":"2022","journal-title":"BMJ Open"},{"key":"2026090719584613700_zvag079-B9","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1186\/s12913-020-05718-0","article-title":"The association between general practitioner regularity of care and \u2018high use\u2019 hospitalisation","volume":"20","author":"Moorin","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026090719584613700_zvag079-B10","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.jval.2017.12.019","article-title":"Economic burden of cardiovascular disease in type 2 diabetes: a systematic review","volume":"21","author":"Einarson","year":"2018","journal-title":"Value Health"},{"key":"2026090719584613700_zvag079-B11","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1001\/archinte.164.13.1422","article-title":"The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up","volume":"164","author":"Almdal","year":"2004","journal-title":"Arch Intern Med"},{"key":"2026090719584613700_zvag079-B12","doi-asserted-by":"crossref","first-page":"e084917","DOI":"10.1136\/bmjopen-2024-084917","article-title":"Global comparison of the economic costs of coronary heart disease: a systematic review and meta-analysis","volume":"15","author":"Shakya","year":"2025","journal-title":"BMJ Open"},{"key":"2026090719584613700_zvag079-B13","author":"Baker IDI Heart & Diabetes Institute, Diabetes Australia, JDRF"},{"key":"2026090719584613700_zvag079-B14","doi-asserted-by":"crossref","first-page":"2907","DOI":"10.1093\/eurheartj\/ehy677","article-title":"Addressing cardiovascular risk in type 2 diabetes mellitus: a report from the European Society of Cardiology Cardiovascular Roundtable","volume":"40","author":"Cosentino","year":"2019","journal-title":"Eur Heart J"},{"key":"2026090719584613700_zvag079-B15","doi-asserted-by":"crossref","first-page":"436","DOI":"10.5694\/mja16.00332","article-title":"Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative","volume":"206","author":"Chalasani","year":"2017","journal-title":"Med J Aust"},{"key":"2026090719584613700_zvag079-B16","doi-asserted-by":"crossref","first-page":"254","DOI":"10.5694\/j.1326-5377.2010.tb03502.x","article-title":"Cardiovascular risk perception and evidence\u2013practice gaps in Australian general practice (the AusHEART study)","volume":"192","author":"Heeley","year":"2010","journal-title":"Med J Aust"},{"key":"2026090719584613700_zvag079-B17","doi-asserted-by":"crossref","first-page":"213","DOI":"10.5694\/mja14.00249","article-title":"Are high coronary risk patients missing out on lipid-lowering drugs in Australia?","volume":"201","author":"Simons","year":"2014","journal-title":"Med J Aust"},{"key":"2026090719584613700_zvag079-B18","author":"Nolte"},{"key":"2026090719584613700_zvag079-B19","author":"Australian Commission on Safety and Quality in Healthcare, Clinical Care Standards"},{"key":"2026090719584613700_zvag079-B20","doi-asserted-by":"crossref","first-page":"e015135","DOI":"10.1136\/bmjopen-2016-015135","article-title":"Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings","volume":"7","author":"Murphy","year":"2017","journal-title":"BMJ Open"},{"key":"2026090719584613700_zvag079-B21","first-page":"758","article-title":"Use of critical pathways to improve efficiency: a cautionary tale","volume":"9","author":"Saint","year":"2003","journal-title":"Am J Manag Care"},{"key":"2026090719584613700_zvag079-B22","volume-title":"Optimal Care Pathways","author":"Cancer Council","year":"2024"},{"key":"2026090719584613700_zvag079-B23","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B24","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B25","doi-asserted-by":"crossref","first-page":"105582","DOI":"10.1016\/j.ijmedinf.2024.105582","article-title":"Implementing privacy preserving record linkage: insights from Australian use cases","volume":"191","author":"Randall","year":"2024","journal-title":"Int J Med Inform"},{"key":"2026090719584613700_zvag079-B26","first-page":"1099","article-title":"Using general practice clinical information system data for research: the case in Australia","volume":"5","author":"Youens","year":"2020","journal-title":"Int J Popul Data Sci"},{"key":"2026090719584613700_zvag079-B27","author":"Australian Commission on Safety and Quality in Healthcare"},{"key":"2026090719584613700_zvag079-B28","first-page":"1741","article-title":"Data Resource Profile: MedicineInsight, an Australian national primary health care database","volume":"48","author":"Busingye","year":"2019","journal-title":"Int J Epidemiol"},{"key":"2026090719584613700_zvag079-B29","doi-asserted-by":"crossref","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2026090719584613700_zvag079-B30","author":"Independent Hospital Pricing Authority"},{"key":"2026090719584613700_zvag079-B31","author":"World Health Organization"},{"key":"2026090719584613700_zvag079-B32","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/s12913-024-10725-6","article-title":"Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system","volume":"24","author":"Samadbeik","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026090719584613700_zvag079-B33","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.hlc.2025.02.102","article-title":"National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: comprehensive Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025","volume":"34","author":"Brieger","year":"2025","journal-title":"Heart Lung Circ"},{"key":"2026090719584613700_zvag079-B34","author":"National Health Performance Authority"},{"key":"2026090719584613700_zvag079-B35","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B36","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5694\/mja12.11854","article-title":"Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study","volume":"199","author":"Chew","year":"2013","journal-title":"Med J Aust"},{"key":"2026090719584613700_zvag079-B37","doi-asserted-by":"crossref","first-page":"238","DOI":"10.31128\/AJGP-02-20-5222","article-title":"Management of patients with type 2 diabetes and cardiovascular disease in primary care","volume":"50","author":"Marson","year":"2021","journal-title":"Aust J Gen Pract"},{"key":"2026090719584613700_zvag079-B38","author":"Living Evidence for Diabetes Consortium"},{"key":"2026090719584613700_zvag079-B39","author":"Australian Bureau of Statistics"},{"key":"2026090719584613700_zvag079-B40","author":"Australian Bureau of Statistics"},{"key":"2026090719584613700_zvag079-B41","doi-asserted-by":"crossref","first-page":"628","DOI":"10.31128\/AJGP-03-21-5866","article-title":"HbA1c: more than just a number","volume":"50","author":"Wang","year":"2021","journal-title":"Aust J Gen Pract"},{"key":"2026090719584613700_zvag079-B42","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/s12874-022-01679-6","article-title":"Survival prediction models: an introduction to discrete-time modeling","volume":"22","author":"Suresh","year":"2022","journal-title":"BMC Med Res Methodol"},{"key":"2026090719584613700_zvag079-B43","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1111\/j.2042-7174.2012.00193.x","article-title":"A review of the medication pathway in rural Queensland, Australia","volume":"20","author":"Tan","year":"2012","journal-title":"Int J Pharm Pract"},{"key":"2026090719584613700_zvag079-B44","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1370\/afm.2308","article-title":"Higher primary care physician continuity is associated with lower costs and hospitalizations","volume":"16","author":"Bazemore","year":"2018","journal-title":"Ann Fam Med"},{"key":"2026090719584613700_zvag079-B45","doi-asserted-by":"crossref","first-page":"j84","DOI":"10.1136\/bmj.j84","article-title":"Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data","volume":"356","author":"Barker","year":"2017","journal-title":"BMJ"},{"key":"2026090719584613700_zvag079-B46","author":"Scully"},{"key":"2026090719584613700_zvag079-B47","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B48","doi-asserted-by":"crossref","first-page":"e600","DOI":"10.3399\/bjgp20X712289","article-title":"Primary medical care continuity and patient mortality: a systematic review","volume":"70","author":"Baker","year":"2020","journal-title":"Br J Gen Pract"},{"key":"2026090719584613700_zvag079-B49","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1186\/s12913-023-09808-7","article-title":"Greater temporal regularity of primary care visits was associated with reduced hospitalizations and mortality, even after controlling for continuity of care","volume":"23","author":"Khazen","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026090719584613700_zvag079-B50","doi-asserted-by":"crossref","first-page":"e003391","DOI":"10.1136\/bmjopen-2013-003391","article-title":"Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality","volume":"3","author":"Honeyford","year":"2013","journal-title":"BMJ Open"},{"key":"2026090719584613700_zvag079-B51","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.cger.2009.07.007","article-title":"The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs","volume":"25","author":"Yazdanyar","year":"2009","journal-title":"Clin Geriatr Med"},{"key":"2026090719584613700_zvag079-B52","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s12872-018-0914-1","article-title":"Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study","volume":"18","author":"Navarro-Perez","year":"2018","journal-title":"BMC Cardiovasc Disord"},{"key":"2026090719584613700_zvag079-B53","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/1753-6405.12807","article-title":"Regional variation in cardiovascular mortality in Australia 2009\u20132012: the impact of remoteness and socioeconomic status","volume":"42","author":"Jacobs","year":"2018","journal-title":"Aust N Z J Public Health"},{"key":"2026090719584613700_zvag079-B54","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1093\/ehjqcco\/qcw025","article-title":"Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident\u2014a systematic review and meta-analysis","volume":"3","author":"Rasid","year":"2016","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026090719584613700_zvag079-B55","doi-asserted-by":"crossref","first-page":"331","DOI":"10.2174\/1573403X10666140214122234","article-title":"Coronary artery disease in patients with chronic kidney disease: a clinical update","volume":"9","author":"Cai","year":"2013","journal-title":"Curr Cardiol Rev"},{"key":"2026090719584613700_zvag079-B56","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/j.1464-5491.2011.03456.x","article-title":"Association between HbA1c and cardiovascular disease mortality in older Hong Kong Chinese with diabetes","volume":"29","author":"Xu","year":"2012","journal-title":"Diabet Med"},{"key":"2026090719584613700_zvag079-B57","author":"Australian Institute of Health and Welfare"},{"key":"2026090719584613700_zvag079-B58","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s00228-023-03539-8","article-title":"Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014\u20132022)","volume":"79","author":"Lin","year":"2023","journal-title":"Eur J Clin Pharmacol"},{"key":"2026090719584613700_zvag079-B59","author":"Australian Commission on Safety and Quality in Healthcare"}],"container-title":["European Journal of Cardiovascular Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjcn\/advance-article-pdf\/doi\/10.1093\/eurjcn\/zvag079\/67392604\/zvag079.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjcn\/article-pdf\/25\/6\/1170\/67392604\/zvag079.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjcn\/article-pdf\/25\/6\/1170\/67392604\/zvag079.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:58:57Z","timestamp":1788825537000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjcn\/article\/25\/6\/1170\/8527928"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":59,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3,18]]},"published-print":{"date-parts":[[2026,9,8]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjcn\/zvag079","relation":{},"ISSN":["1474-5151","1873-1953"],"issn-type":[{"value":"1474-5151","type":"print"},{"value":"1873-1953","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,3,18]]}}}